Description :

1. Identified key data elements aligning with insurance practices and regulatory standards.
2. Analyzed updates to service codes, ensuring compliance with insurance guidelines.
3. Collaborated with coding and compliance managers to implement billing updates.
4. Supported reviews of coding issues, enhancing operational efficiency.
5. Standardized coding practices across multiple physician billing operations.
6. Assigned ICD and CPT codes, ensuring documentation accuracy.
7. Validated treatment codes to confirm medical necessity, optimizing reimbursement.

Experience

0-2 Years

Level

Entry Level

Education

BSHIM

Description :

1. Managed coding discrepancies for a multi-specialty network, ensuring accurate claim submissions.
2. Trained new coding staff in compliance protocols and coding practices.
3. Executed EM coding for various specialties, including Palliative Care.
4. Researched and applied coding guidelines for diverse insurance carriers.
5. Presented educational sessions on coding practices at quarterly meetings.
6. Conducted audits of physician documentation, utilizing the 95 auditing tool.
7. Documented and analyzed audits on surgical procedures for compliance adherence.

Experience

0-2 Years

Level

Junior

Education

AAS-HIT

Description :

1. Executed thorough audits on charges during the implementation of a new EMR system, ensuring compliance and accuracy.
2. Reviewed and optimized office note templates, providing actionable feedback to physicians for improved documentation.
3. Delivered coding education sessions, resulting in enhanced understanding of coding standards among staff.
4. Conducted random chart audits, validating charge accuracy against patient documentation.
5. Maintained ongoing communication with healthcare providers during software transitions, addressing documentation concerns.
6. Developed compliance tools for offices, ensuring adherence to documentation standards.
7. Kept abreast of evolving coding guidelines and regulations, ensuring that practices remained compliant.

Experience

5-7 Years

Level

Senior

Education

BSHIM

Description :

1. Analyzed code to identify bugs and optimize performance for software applications.
2. Collaborated with developers to design and implement efficient coding solutions.
3. Reviewed medical documentation and consulted with healthcare providers to clarify coding-related ambiguities.
4. Maximized reimbursement through precise ICD-9-CM and CPT coding practices.
5. Achieved a $500,000 increase in hospital reimbursement through an intensive physician query process.
6. Reviewed and maintained existing codebases to ensure quality and functionality.
7. Developed and executed test plans to validate software functionality and performance.

Experience

5-7 Years

Level

Senior

Education

B.S. in HIM

Description :

1. Reconciled DataRAP payment reports, processed payments for providers, and collaborated with IT to resolve reporting deficiencies.
2. Produced comprehensive monthly reports and provided documentation feedback to physicians under the guidance of the Coding Operations Manager.
3. Managed attestation sheets and progress notes in accordance with DataRAP department guidelines.
4. Analyzed provider documentation for validation following CMS guidelines and entered final results into the DataRAP database.
5. Communicated with PCPs regarding documentation standards using the DataRAP application.
6. Ensured accuracy of diagnosis entries by validating attestation outcomes.
7. Reported quality concerns to the Clinical Process Quality Analyst to facilitate training and education.

Experience

7-10 Years

Level

Management

Education

BSHIM

Description :

1. Applied ICD-10 and CPT codes to patient encounters, ensuring compliance with healthcare regulations and guidelines.
2. Conducted in-depth audits of coding discrepancies, collaborating with clinical staff to resolve issues promptly.
3. Oversaw risk adjustment coding processes, ensuring accurate documentation for optimal reimbursement.
4. Identified and addressed inconsistencies in medical data, proactively engaging with healthcare teams to rectify issues.
5. Maintained up-to-date knowledge of coding guidelines and regulatory changes to ensure compliance.
6. Utilized coding reference materials to enhance coding accuracy and efficiency in documentation.
7. Consistently met and exceeded productivity and quality standards set by the organization.

Experience

7-10 Years

Level

Management

Education

BSHIM

Description :

1. Abstracted data from electronic medical records, assigning accurate ICD-10 and CPT codes to ensure compliance and reimbursement.
2. Coded surgical cases, both major and minor, across office and hospital settings to enhance billing accuracy.
3. Reviewed and ensured correct coding of all EM visits, facilitating timely reimbursements.
4. Conducted audits of coding practices to identify discrepancies and implement corrective actions.
5. Utilized software tools to edit coding errors for various insurance companies, ensuring compliance with CCI Edits and McKesson Contract.
6. Collaborated with healthcare teams to support accurate documentation and coding practices.
7. Managed and prioritized coding workloads across multiple clinics, optimizing team efficiency.

Experience

10+ Years

Level

Executive

Education

BSHIM

Description :

1. Managed comprehensive coding of medical records, ensuring accurate ICD-10 and CPT coding for diverse specialties.
2. Conducted thorough audits of coding practices, identifying discrepancies and implementing corrective actions.
3. Collaborated with physicians to clarify documentation, enhancing coding accuracy and compliance.
4. Led training sessions for coding staff on updated coding guidelines and best practices.
5. Analyzed coding data to identify trends, informing process improvements and compliance strategies.
6. Developed coding policies and procedures that align with regulatory requirements.
7. Facilitated communication between coding and billing departments to optimize revenue cycle processes.

Experience

10+ Years

Level

Executive

Education

BSHIM

Description :

1. Specialized in coding for various medical specialties, including General Surgery, Orthopedics, and ENT.
2. Managed Pro-fee coding for OBGYN services, including clinic visits and deliveries.
3. Analyzed and resolved denials and patient inquiries efficiently.
4. Provided ongoing education and constructive feedback to healthcare providers and staff.
5. Oversaw coding accuracy for a team of over 30 physicians across multiple specialties.
6. Utilized CPT, ICD-10, and HCPCS coding systems, along with 3M encoder tools.
7. Conducted regular audits to ensure compliance and improve coding standards.

Experience

2-5 Years

Level

Consultant

Education

B.S. in HIM

Description :

1. Reviewed and analyzed health information documentation to accurately identify diagnoses and procedures affecting patient encounters.
2. Utilized formal training in medical terminology and reimbursement methodologies to enhance coding accuracy.
3. Applied CPT guidelines to assign and sequence codes for services rendered effectively.
4. Executed coding in accordance with CCI Bundling Guidelines to ensure compliance.
5. Leveraged HCPCS coding systems to enhance billing accuracy and efficiency.
6. Utilized CMS resources to verify medical necessity and compliance with coding edits.
7. Collaborated with healthcare teams to ensure accurate and comprehensive documentation practices.

Experience

2-5 Years

Level

Freelancer

Education

BSHIM